Fluoride varnishes for preventing dental caries in children and adolescents

Marinho VCC, Higgins JPT, Logan S, Sheiham A

Published Online:

January 21, 2009

Fluoride varnishes applied professionally two to four times a year would substantially reduce tooth decay in children.
Fluoride is a mineral that prevents tooth decay (dental caries). Since widespread use of fluoride toothpastes and water fluoridation, the value of additional fluoride has been questioned. Fluoride varnishes can be professionally applied at a frequency from two to four times a year. The review of trials found that fluoride varnish can substantially reduce tooth decay in both milk teeth and permanent teeth. However, more high quality research is needed to be sure of how big a difference the treatment makes, and to study acceptability and adverse effects

Abstract (click to read)

Background:

Topically applied fluoride varnishes have been used extensively as an operator-applied caries-preventive intervention for over 2 decades.

Objectives:

To determine the effectiveness and safety of fluoride varnishes in the prevention of dental caries in children and to examine factors potentially modifying their effect.

Search strategy:

Multiple electronic database searches, reference lists of articles, journal handsearch, selected authors and manufacturers.

Selection criteria:

Randomised or quasi-randomised controlled trials with blind outcome assessment, comparing fluoride varnish with placebo or no treatment in children up to 16 years during at least 1 year. The main outcome was caries increment measured by the change in decayed, missing and filled tooth surfaces (D(M)FS).

Data collection and analysis:

Inclusion decisions, quality assessment and data extraction were duplicated in a random sample of one third of studies, and consensus achieved by discussion or a third party. Study authors were contacted for missing data. The primary measure of effect was the prevented fraction (PF), that is the difference in caries increments between the treatment and control groups expressed as a percentage of the increment in the control group. Random-effects meta-analyses were performed where data could be pooled. Potential sources of heterogeneity were examined in random-effects metaregression analyses.

Main results:

Nine studies were included, involving 2709 children. For the seven that contributed data for the main meta-analysis, the D(M)FS pooled prevented fraction estimate was 46% (95% CI, 30% to 63%; P < 0.0001). There was substantial heterogeneity, confirmed statistically (P < 0.0001). The pooled d(e/m)fs prevented fraction estimate was 33% (95% CI, 19% to 48%; P < 0.0001). No significant association between estimates of D(M)FS prevented fractions and baseline caries severity or background exposure to fluorides was found in metaregression, and a funnel plot of the seven studies indicated no relationship between prevented fraction and study precision. In both methods, power is limited when only a few trials are included.

Authors' conclusions:

The review suggests a substantial caries-inhibiting effect of fluoride varnish in both the permanent and the deciduous dentitions based largely on trials with no treatment controls. There is little information concerning acceptability of treatment or possible side effects in the included trials. Given the relatively poor quality of most of the included studies and the wide confidence intervals around the estimates of effect, there remains a need for further trials. It is important that these trials should be of high quality and include assessment of potential adverse effects.

This record should be cited as:

Marinho VCC, Higgins JPT, Logan S, Sheiham A. Fluoride varnishes for preventing dental caries in children and adolescents. Cochrane Database of Systematic Reviews 2002, Issue 3. Art. No.: CD002279. DOI: 10.1002/14651858.CD002279

Assessed as up to date:

November 26, 2001

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Primary Review Group:

Oral Health Group

Health topics:

Dentistry & oral health > Dental caries > Prevention

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Fluoride varnishes for preventing dental caries in children and adolescents

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